Clinician's Digest

Clinician's Digest

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Clinician's Digest By Garry Cooper

Research and the Media

On June 2, the New York Times announced the results of a "landmark" National Institute of Mental Health (NIMH) study on treating adolescent depression. Other major media, including The Today Show , immediately picked up on the article, and in less than 24 hours, the "news"--that fluoxetine hydrochloride (Prozac) in combination with cognitive-behavioral therapy (CBT), or fluoxetine alone, is highly effective, and that CBT by itself is little more effective than placebo--had been broadcast around the country. Picking up on the Times nomenclature, CBT often got translated in news reports as "talk therapy." As a result, millions of American parents were left with the impression that Prozac should be the first line of treatment for depressed adolescents, and that psychotherapy alone isn't much use.

Lost in the media hype was the crucial fact that the results that the Times had reported were the preliminary results of a preliminary study that hasn't yet been peer reviewed. And the fact is that until the study undergoes peer review, several important questions about its findings will remain unanswered

Consumer advocate Vera Hassner Sharav, whose Alliance for Human Research Protection exposes harmful and misleading medical research, sees the hand of the pharmaceutical industry behind the Times' s premature publication. At least two of the study's primary researchers, she says, have substantial and ongoing financial ties with several pharmaceutical companies, including Eli Lilly, which manufactures Prozac.

But Times reporter Gardiner Harris, who wrote the article, claims that the researchers were unhappy that he wrote his story. Harris heard about the study at a meeting of psychiatric drug researchers in Phoenix, the type of venue where researchers often present studies prior to peer review to colleagues who understand the limited value of the results. "Harris was probably used," says Sharav, who wonders why he was allowed to attend such a meeting in the first place. Oddly enough, two months earlier, on April 9, Harris published an article that began, "Pediatricians and family physicians should not prescribe antidepressants for depressed children and adolescents because the drugs barely work and their side effects are often significant."

Until the study of the 378 depressed adolescents is peer reviewed and published--the preliminary results reported cover only a 12-week treatment period, and the entire study will run for years--several important questions hang in the balance. Why did previous studies of CBT and adolescent depression show significantly stronger results for CBT--so positive that the American Academy of Child and Adolescent Psychiatrists guidelines recommend CBT as "a viable treatment option effective in a majority of adolescents"? And why are the results of the preliminary study more favorable to fluoxetine than some previous studies with adolescents have been?

Meanwhile, although millions of parents now think they know the best treatment for adolescent depression, until peer review, publication, and vigorous discussion and analysis of the short- and long-term stages of the study take place, the real answer remains unclear.

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